Care Bill [Lords]

Andy Burnham Excerpts

Monday 16th December 2013 Commons Chamber

[Mr Hunt]

The reason I am talking about this is that the hon. Lady’s party has decided to oppose the Bill. Let us look at the measures in the Bill that Labour is opposing.

[Andy Burnham (Leigh) (Lab)]

Will the Minister give way?

[Mr Hunt]

I will make some progress, then I will give way.

Labour will today vote against measures that will help to implement 61 of the most important recommendations made by Robert Francis. Many of these will be policed by the new chief inspector of hospitals, appointed to be the nation’s whistleblower in chief, whose duties will be enshrined in today’s legislation, which Labour are voting against.

[Andy Burnham]

How can it be appropriate to introduce a debate on such fundamentally important issues as the way we care for older people with such narrow, petty, partisan, point scoring efforts? May I just say to the Secretary of State that he should not stand there and misrepresent the position of the Opposition? We will not oppose the Second Reading—we have tabled a reasoned amendment, because we do not believe his proposals for a cap are what they seem, but we will not oppose the Second Reading of this Bill. He should get his facts straight before he comes to that Dispatch Box.

[Mr Hunt]

The right hon. Gentleman needs to read his own amendment, because it says that he “declines to give” the Bill “a Second Reading”. If he is changing his position now, that is the fastest U-turn in history.

Let me go on to say why it is so important that the Labour party supports today’s Bill and does not, as the amendment says, decline to give the Bill a Second Reading.

[Mr Hunt]

I am going to make some progress. The new chief inspector of hospitals will act as Ofsted does with schools and, as with Ofsted, will inspect and rate hospitals using simple language that the public can understand: “Is my local hospital safe? Is it caring? Is it responsive? Is it clinically effective? Is it well led?” We will also make sure that the same scrutiny is directed at services outside hospitals, so the Bill makes provision for a chief inspector of social care and a chief inspector of general practice.

Ministers in the previous Government were repeatedly asked to strengthen the regulatory system and repeatedly ignored those requests. [Interruption.] The right hon. Gentleman says, from a sedentary position, that that is rubbish, but this is what Barbara Young, the chair of the Care Quality Commission at the time and now a Labour peer, told the Francis inquiry about the inspection system that the right hon. Gentleman introduced:

“The annual health check was so flawed in so many ways that I went and saw the Secretary of State. It was nonsense. And having argued that with the Secretary of State, I was told firmly that we weren’t permitted to change it. I was very unhappy about that.”

Well, today—

[Andy Burnham]

rose—

[Mr Hunt]

No, I am going to make some progress. Today he had a chance to show that he had learned how wrong—

[Andy Burnham]

On a point of order, Mr Speaker. Is it in order for the Secretary of State to misrepresent the views of the previous Government and previous Ministers, and refuse to take interventions? He has just said that I refused to change and strengthen the regulation system of hospitals in England—that is factually incorrect. I brought forward a new system for the registration of all hospitals in England in autumn 2009, on the back of recommendations from the CQC. Again, he should get his facts straight at that Dispatch Box.

[Mr Speaker]

I am grateful to the right hon. Gentleman for his point of order, and I make two points in response. First, every Member and every Minister must be responsible for his or her comments in the Chamber—the accuracy and appropriateness thereof. I am afraid that, however angry people feel, on either side of the argument, these are matters of debate. Secondly, the situation would be greatly helped if the Secretary of State now, immediately, turned his mind to the presentation of the argument in support of the introduction of the Bill, which is, ordinarily, the matter upon which one anticipates a Secretary of State will focus his remarks. This is not an occasion for a historical legerdemain; it is an occasion for the presentation of the case for a Bill, to which I know that, without delay, the Secretary of State will turn his mind.

--- Later in debate ---

[Mr Hunt]

I am going to make some progress.

Thanks to our reversal of Labour’s 2004 GP contract, vulnerable people over 75 will have an accountable, named GP responsible for making sure they get the wraparound care they require.

The collapse of Southern Cross showed the risks to people’s care when providers fail, so through the Bill we are introducing provisions to help ensure that people do not go without care if their provider fails, even if they pay for their own care. The CQC will monitor the financial position of the most difficult-to-replace providers in England to help local authorities provide continuity of care in a way that minimises anxiety for people receiving care.

We also need to improve the training of health care assistants and social care support workers. For the first time, health care assistants will have a new care certificate to ensure they get training in compassionate care and the Bill allows us to appoint a body to set the standards for that training. That means that the public can be assured that no one will be assigned to give personal care to their loved ones without appropriate training or skills. My hon. Friend the Minister of State, who is responsible for care and support, will have more to say on those elements of the Bill when he closes the debate and I thank him for his outstanding work on raising standards in that area.

We also need to address the funding of care. At the moment, people fear being saddled with catastrophic costs and even having to sell their home at the worst possible time to pay for their care. The Care Bill significantly reforms the funding of care and support, introducing a duty on local authorities to offer a deferred payments scheme so that people will not be forced to sell their homes in their lifetime to pay for residential care.

We will also introduce a cap on people’s social care costs, raising the means test at which support from the state is made possible and delivering on the recommendation of the independent Dilnot commission.

[Andy Burnham]

Will the Secretary of State give way?

[Mr Hunt]

I am going to make some progress.

Some 100,000 older people will benefit financially and everyone will be protected from the catastrophic cost of care.

--- Later in debate ---

[Mr Hunt]

My hon. Friend is right. We followed the recommendations of Andrew Dilnot, who did not think that the cap should apply to hotel costs, and, indeed, the policy that the Opposition followed in their national care service White Paper. We think that it is reasonable to cap the care costs. There is a cost issue—we would like to be more generous, but by the end of the next Parliament this proposal will cost nearly £2 billion. People who would like a more generous system must be obliged to tell us where they will get the extra funding.

[Andy Burnham]

rose—

[Mr Hunt]

The right hon. Gentleman will have a chance to speak later.

We want to be one of the first countries in the world where it is as normal to save for one’s social care costs as it is for one’s pension, and this Bill’s provisions make that possible. The deferred payments scheme, with a threshold of £23,250, on which we openly consulted, excludes only the wealthiest 15% of people entering residential care. How extraordinary it is that Labour should play politics by feigning concern for the richest in society, when they failed to do anything for the poorest over 13 years when they had the chance to do so.

--- Later in debate ---

[Andy Burnham (Leigh) (Lab)]

I beg to move

That this House, whilst affirming its belief that the Care Bill [Lords] is a modest step towards a better social care system that protects some people from catastrophic costs, and welcoming the new rights for users and carers that the former Labour Government initiated, notes that the Bill’s deferred payment scheme will result in people continuing to have to sell their homes to pay for care; disagrees with the Government’s assertion that their proposals will cap care costs at £72,000 given that self-funders will face far higher bills; further notes that it includes provisions which could put NHS hospitals at risk of having services reconfigured without adequate consultation and without clinical support; further notes that the Bill fails to include measures to address the current crisis in care and meet the needs of the UK’s ageing population, including a genuinely integrated NHS and social care system; and therefore declines to give a Second Reading to the Care Bill [Lords] because it is an inadequate response to the scale of the challenge facing social care and fails fully to implement the recommendations of the Francis Report.

The Bill began as a response to the Dilnot report and a reform of social care, but has since taken in major new measures on the NHS. It deals with issues that matter greatly to millions—issues to which that very thin speech we have just heard did not do justice. Worse, it was an inappropriate attempt to turn an occasion such as this into the latest stage of the Secretary of State’s political smear campaign. I refuse to sink to his level, and instead will deal with the important issues before the House today. For clarity, I will take the issues separately—social care, then health.

Providing good care for all older and disabled people and finding a fair way to pay for it is the greatest unresolved public policy challenge of our times. The failure of successive Parliaments to face up to it has left in place today a care system in England which is underfunded, overstretched—[Interruption]—and in danger of being overwhelmed—a malnourished, minimum wage service where care is given in 15-minute slots, with barely time to make a cup of tea, let alone have a meaningful conversation or make someone comfortable.

[Alison McGovern (Wirral South) (Lab)]

Members can hardly say “Ah!” after the performance that we just saw at the Dispatch Box. On the important issue of social care that my right hon. Friend is coming to, he knows that 100 or more of my constituents turned up on a Friday evening to talk to me about that. They want to hear from us today what we are going to do to fix the culture of low pay and poor conditions in social care, so will he say what he thinks local authorities can do, especially given the level of cuts that they face from this Government?

[Andy Burnham]

The issues are huge. They affect every family in this country and the worries they have about how they will look after their mum and dad in later life. They did not hear any answers from the Government this afternoon. I hope my hon. Friend will hear a few from me. I know that she has campaigned on the use of zero-hours contracts in our care system. Is it not a sad reflection on both sides of the House that today in England around 300,000 care staff are working on zero-hours contracts? They do not have the security of knowing what they will earn from one week to the next, so how can we expect them to pass on a sense of security to those they care for? Is not the message that we are sending to people who work in our care service, particularly young people coming into the service, that looking after someone else’s mum or dad is the lowest calling they can answer, when really it should be the very highest?

[Julie Hilling]

Would my right hon. Friend have been as shocked as I was yesterday when I met the carer of a woman who will be 99 next week and discovered that she has a five-minute call at tea time and a 10-minute call at bed time?

[Andy Burnham]

I would like to say that I would have been shocked, but I know that the system just gets worse and worse each year as the pressure builds and corners have to be cut, and it is older people and their families who are paying the price. How can any “care” be given in five minutes? Of course it cannot. It does not make financial sense in the long run, because we have a care system that does not provide people with support in their own homes, buts leaves them to drift towards hospital, leaving our acute hospitals increasingly and unsustainably full of frail older people.

[Richard Graham (Gloucester) (Con)]

I am slightly confused, because we have been called to the House today to debate the amendment tabled by the right hon. Gentleman, which states that this House

“declines to give a Second Reading to the Care Bill”,

but I thought I heard him tell the Secretary of State for Health earlier that he is not opposing the Bill’s Second Reading. Will he please clarify that?

[Andy Burnham]

I would have thought that the hon. Gentleman had been here long enough to know the difference by now. We will not oppose the Bill, in the sense that we will not vote against it on Second Reading, but it contains measures to which we simply cannot give a clear endorsement, as I will go on to explain. That is the purpose of our reasoned amendment. We will not oppose the Bill’s passage on Second Reading, which is why I objected to the Secretary of State misrepresenting my position.

[Andrew George]

I was going to make a similar point. Is it wise to bring forward an amendment of the type the right hon. Gentleman has tabled, bearing in mind the rather partisan nature of the debate we have had so far? What we really wanted was a debate on the Bill’s contents. Does he not now regret having brought forward such an amendment, because it has precipitated our going down into the gutter of partisan politics?

[Andy Burnham]

I agree with the hon. Gentleman, which is why I am not opportunistically opposing the Bill. I have tabled a reasoned amendment to put on the record the very serious concerns people have about funding for local authority care in England, the way the new cap will work and, in particular, the proposed clause on hospital reconfiguration—the Lewisham clause. I cannot let those concerns pass without making clear our position on them from the Dispatch Box. That is why we have taken that stand. That is why I am seeking to introduce my remarks in a non-partisan way.

[Jacob Rees-Mogg (North East Somerset) (Con)]

Will the right hon. Gentleman give way?

[Andy Burnham]

No, I want to make some progress.

I described the care system we have in England. Surely we can do better. In the last Parliament, the previous Government began a serious attempt at reform. I give this Government credit for continuing some of that work. The Bill contains many proposals originally put forward in my White Paper “Building the National Care Service”, published in February 2010. What most people will remember from the pre-election period was the clash between the parties on funding solutions, but what they might not have realised is that beneath the rhetoric there was much common ground on other matters. I hope that people will welcome that, just as we welcome some of the measures that are carried forward into the Bill.

First, stronger legal rights and recognition for carers are well overdue. For far too long, informal and family carers have been invisible to the system and taken for granted. That simply cannot go on. If statutory services are to be sustainable in the 21st century, they must learn to value informal care and carers and help them do more to help their loved ones. Secondly, we welcome efforts to simplify the social care system. Better information and advice will make a difference to some people. Unifying social care legislation in line with the recommendations of the Law Commission review initiated under the previous Government is sensible and overdue. Thirdly, the idea of a cap on the overall costs of care that individuals can face establishes the important principle that people should not lose everything they have worked for because of their vulnerability in later life.

I am happy to say that those are all important steps forward that we would not seek to oppose. However, let me be clear—this answers the points raised by Government Members—that this Bill is not equal to the scale and the urgency of the care crisis in England. It fails to implement the Dilnot report and does not provide a lasting solution. It does little or nothing to improve care services now or to reduce the costs of care for most people; in fact, it is likely to make things even worse. That is why we have tabled a reasoned amendment to draw the House’s attention to two major problems with the Government’s approach. First, prioritising funding a cap over and above protecting existing council budgets means that the care system will continue to go backwards and get worse, not better. In short, the Government are promising future help instead of helping people right now. Secondly, the proposed £72,000 cap is not what it seems; it is a care con.

On funding priorities, the Government are failing to face up to the scale of the funding crisis facing councils right now. In the cross-party talks on the Dilnot report, Labour stated a clear principle that the cap and the council baseline must be considered together as equal priorities. That was supported by Andrew Dilnot himself, as the right hon. Member for Sutton and Cheam (Paul Burstow) may remember, because he was also party to those talks. As a first step, we called on the Government to use some of last year’s NHS underspend to tackle the care crisis—and, by extension, to ease pressure on A and E—instead of handing the money back to the Treasury. The Government have not listened to that, and this Bill makes matters worse for local authorities by placing new, unfunded and uncosted burdens on them. The fact that it restricts the eligibility of those in substantial or critical need of support is, in itself, a clear admission on the Government’s part that the support system overall is being scaled back.

[Mrs Madeleine Moon (Bridgend) (Lab)]

I spent 30 years making assessments of people who were in care and addressing the care that they needed, often while working in hospitals to get them discharged. After 30 years, the same problem exists: there is not enough money in local government to pay for the care to get people home early to have the rehabilitation they need at home, with the quality of care to make sure that they do not deteriorate further and end up back in the hospital system. This Bill will not tackle that fundamental underlying problem.

[Andy Burnham]

My hon. Friend is absolutely right. This Bill promises far-off help for people while services are getting worse right now, because the Government have failed to address the crisis in local government’s ability to fund social care.

[Sheila Gilmore (Edinburgh East) (Lab)]

Will my right hon. Friend give way?

[Andy Burnham]

I shall in a moment.

What are the direct and practical effects of those cuts to council budgets? First, councils have cut eligibility criteria, so more people are exposed to care charges in a way that they were not before. Secondly, those care charges are now rising above inflation year on year, so more people are exposed to higher charges. This means that they are now more likely to pay right up to the new cap that the Government are introducing. That will not feel like progress to the public, and that is why we are making our reasoned objection to the Bill.

[The Minister of State, Department of Health (Norman Lamb)]

I am sure the right hon. Gentleman agrees it is important that we are accurate about these matters. He suggested that the Bill “restricts”—that is the word he used—eligibility for substantial or critical care. Does he accept that it does not do that, and that any council that wants to have more generous eligibility can continue to do so?

[Andy Burnham]

I do not disagree with the approach of setting national eligibility criteria and taking a national view, so I agree with the Minister on that. The problem, however, is that if the Government legislate for just critical and substantial levels, they are sending a very clear message to local government that they believe they can only afford to fund it at those levels. Surely the criteria would have been set higher if they were funding local government better.

The truth is that when this Government came to office, many more councils in England were providing social care at “moderate” level. That has been slowly cut back and now only about 23 councils are still providing support to people with moderate needs. It is a fair bet that those councils will soon be unable to provide moderate care and shrink back to providing only critical and substantial care.

[Norman Lamb]

Does the right hon. Gentleman accept that more than 100 councils were setting the eligibility criteria at “substantial” when his party left office? Is he saying that a future Labour Government would fund eligibility criteria at moderate level? If so, how would he fund it?

[Andy Burnham]

That is a political point; let me deal with it. When we left government, 38 councils were providing some free care to people with either low or moderate needs. I correct the figure I gave a moment ago: it is, in fact, 15 councils that are now doing that. The care system is being scaled back. Therefore, people are more liable to charges and are more likely to have to pay them, because support is being withdrawn from people in the home.

[Several hon. Members]

rose—

[Andy Burnham]

I was about to explain that those charges are increasing quite quickly, but first I will give way to my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), who has done so much to raise these issues.

[Barbara Keeley]

I thank my right hon. Friend for giving way and I am surprised and disappointed that the Secretary of State would not give way.

My local council, Salford local authority, is one of the many that are reluctantly having to cut their eligibility criteria this year. Salford tried to stick with the moderate level and this is the third year of cuts. The council has lost £100 million over the past three years and it will lose another £75 million before the Bill’s reforms are implemented. That is a 20% cut in adult social care. How can any of the Health Ministers, whose southern local authorities are not affected in the same way, think that our northern councils can afford this?

[Andy Burnham]

Those are the facts. The councils that are still trying to provide support to people with moderate needs are not all, but by and large, Labour councils. They are still trying to do that, but they have lost significantly more per head under this Government than councils elsewhere. The situation is about to get a lot worse, because NHS England will meet tomorrow to consider a major change to the NHS resource allocation formula, which will reduce the weighting given to health inequality and increase the weighting given to age. That will have the effect of taking more money out of Salford and Wigan and giving more money to areas where healthy life expectancy is already the longest. The Government are making it impossible for people who want to do the right thing.

[Mr Jeremy Hunt]

Local authority budgets were indeed cut to deal with the deficit, so will the right hon. Gentleman tell the House whether he would reverse those cuts—yes or no?

--- Later in debate ---

[Andy Burnham]

The Secretary of State may remember that when he came into government he stood on a manifesto promising real-terms increases. He and the Prime Minister have stood at the Dispatch Box every week since the election saying that I said that we would cut the NHS, but that is not the case: I stood on a manifesto promising protection for the NHS in real terms. I said that if there were to be real-terms increases they should be given to social care instead, because it would be “irresponsible”—that was the quote—if the Government overfunded the NHS only to let social care services collapse: it would be a false economy, because it would push more and more older people into hospitals, and hospitals would stop functioning.

Do you know what? That is happening right now. The Secretary of State’s cuts to social care are forcing more and more older people into hospital. That is why he has an A and E crisis—because hospitals are full. On his watch there has been a 66% increase in people aged over 90 going into A and E via blue-light ambulances. If he is proud of that, that is up to him, but I certainly would not be.

[Mr Andy Slaughter (Hammersmith) (Lab)]

I am not surprised that the Secretary of State wants to change the subject, because if that decision is confirmed tomorrow my clinical commissioning group will lose £29 million—13% of its budget for hospital care. It has some of the poorest health outcomes, but that money will go to places where life expectancy and health outcomes are much better—in other words, Tory-controlled areas. That is a disgrace, coming on top of the closure of fine hospitals such as Charing Cross and emergency hospitals. That is the truth about what this Secretary of State is doing and I am afraid that all we have heard today is political spin.

[Andy Burnham]

The Secretary of State began by quoting the principles of the NHS. I was always led to believe that one of the principles is that the NHS should respect need—that funds should follow those in greatest need. [Interruption.] The Secretary of State says, “Absolutely.” In constituencies in parts of London, the midlands, the north-west, Yorkshire and the north-east, male life expectancy is 10 years lower than in other parts of the county. There is real need in those communities, but they will be the biggest losers if the change goes ahead. I believe that it is immoral to take money out of those communities to hand it to areas where life expectancy is already longer.

I hope that NHS England is listening to this debate. Quite apart from the morality of whether the change should be made, how is it that a quango can distribute about £80 billion of public money to our constituencies while we seemingly have no locus whatever in such a decision? Should not the Secretary of State be at the Dispatch Box either to defend changes that he makes or to say that such changes will not go ahead, so being accountable to this House? Instead, a quango—the biggest in the world—seems to be about to take money out of some of the most deprived parts of the country.

[Kate Green]

I was very disappointed that the Secretary of State would not give way to me, because he did not once mention the position of disabled people in his opening remarks. Does my right hon. Friend not agree that councils being forced to raise the threshold to “substantial” or “critical” will pile up costs for disabled people and their isolation? They cannot get access to moderate levels of care, go out to work or volunteer in their communities, but are shut at home unable to participate. That is bad for them, and it is a false economy.

[Andy Burnham]

I could not agree more. I would guess that disabled people listening to the debate today will be very worried about what they are hearing. The change will restrict support for them, and it is a false economy. If they cannot go out to work, how on earth does that help them or, indeed, anybody? The change will have an impact on disabled people, with some losing their support.

I was going on to make the point that disabled people and older people are already paying much more for care as a result of changes in recent years. As research by my hon. Friend the Member for Leicester West (Liz Kendall) has shown, they are paying almost £740 more a year for vital home case services compared with 2010, up on average by almost £50 a month. That is a hidden cost of living crisis, because who sees that older people have to pay more out of their bank accounts? It goes unnoticed by the media and large parts of society, but the most vulnerable people in society are bearing the brunt.

[Dr Sarah Wollaston (Totnes) (Con)]

I am glad that the right hon. Gentleman has mentioned older people. Does he accept that although health inequalities are very important in setting funding formulas, age is one of the greatest predictors for establishing need? It is absolutely vital to include such factors as age and rurality in deciding funding formulas, and it is precisely to remove the politicisation of such decisions that we are handing them over to another body.

[Andy Burnham]

The hon. Lady must have misunderstood me. I am not saying that age is unimportant; I am saying that age is important, but so is need. In my view, those two must have equal weighting in the system, as they do at the moment. As I understand it, the proposal is to deprioritise need or deprivation as part of the funding formula, which will have the effect of removing funding from communities in which the expectancy for a healthy life is already shortest. I do not believe that that is defensible, and I would be surprised if she found that it was.

[Dr Wollaston]

Will the right hon. Gentleman give way?

[Andy Burnham]

I shall do so once more, but then I must make some progress.

[Dr Wollaston]

The right hon. Gentleman is being generous in giving way. The point is that we are discussing the Care Bill and how need relating to age is the single greatest predictor of someone’s need. I accept that health inequality is a very important factor, but the formula currently does not take enough note of age-based need and multiple long-term conditions.

[Andy Burnham]

I am not sure that I agree with the hon. Lady. Some older people in my constituency probably do not have as good a quality of life in later life as some in her area, because there are ex-miners with chronic obstructive pulmonary disease and other things, who have very extensive needs caused by the dangers they were exposed to during their working life, and that places a burden on our health service. Of course, people are more likely to be living with chronic disease in more deprived areas, and both those things have to be recognised in the funding formula. If the change goes ahead, it will cause great volatility and move a lot of money around the system, but it will not allow areas such as the one I represent to invest in the home-based, high-quality, integrated services that the Secretary of State said he wanted.

To return to the costs of care charged by councils, let us call the hikes in charges what they are—stealthy dementia taxes that seek out the most vulnerable people in our society. The more vulnerable someone is and the greater their need, the more they pay. People who are paying more for care under the current Government and often receiving a worse service will not be convinced by the Secretary of State’s claims for his Bill today. It will feel like a con, and that feeling will only intensify when people understand more about the proposed cap.

Although we welcome the principle of a cap, this one is not what it seems. It is set at £72,000, despite Dilnot warning that a cap above £50,000 would not provide adequate protection for people with low incomes and low wealth. The Health Secretary has repeatedly said that people will not have to pay more than £72,000 for care.

[Mr Jeremy Hunt]

indicated assent.

[Andy Burnham]

The Secretary of State is nodding, but I hope he will be honest enough to admit today that that is simply not the case. In reality, the average pensioner could pay more than £150,000 for their actual residential care home bill—£300,000 for a couple—before they hit the so-called cap. I will explain why. It is because the cap will be based on the standard rate that local authorities pay for a care home place, not the actual amount that self-funders are charged, which is often much higher than the council rate. It is estimated that in 2016-17, when the cap is due to start, the average council rate for residential care will be £522 a week, and the average price of a care home place will be £610 a week. That is because self-funders pay more than councils. However, that will not be taken into account when the cap is calculated.

[Paul Burstow (Sutton and Cheam) (LD)]

Will the shadow Secretary of State confirm to the House that the use of notional costs, which he is describing, was not a Government proposal but one of the Dilnot commission’s recommendations?

[Andy Burnham]

I remember that the right hon. Gentleman showed a good deal of support for the Dilnot proposals, as did we, but they worked as a clever package. They were carefully constructed to ensure that the system would work, be progressive and provide support to everybody. They have now been pulled apart and different figures have been introduced.

[Paul Burstow]

indicated dissent.

--- Later in debate ---

[Andy Burnham]

The right hon. Gentleman shakes his head, but a £72,000 cap is not what Dilnot recommended. That is the Government’s problem. As I said before, the cap will not cover hotel and accommodation costs, either. When both factors are taken into account, an average person in England will take almost five years to hit the so-called cap. Based on average stays in care homes, that means that six out of seven elderly people will have died before they reach it.

If that were not bad enough, people are about to find out that the promises that they will not have to sell their home are also a con. The ability to defer payment for care was one of Andrew Dilnot’s central proposals designed to stop people worrying about selling their home while they were alive. He said that old people would be able to borrow from the local council and repay care bills from what they left behind. The Government initially said that they would implement that proposal and introduce what they called a universal deferred payments scheme. I remember when they used to call that type of proposal a death tax, but things have seemingly moved on for the better.

However, on the day when Parliament rose for the summer recess, the Department sneaked out a consultation document saying that pensioners would not qualify for any help under the universal deferred payment scheme until their savings and other assets, such as valuable possessions, had been run down to below £23,250. That new condition will prevent almost half of those who would otherwise have been able to take advantage of that apparently universal scheme from accessing it.

[Norman Lamb]

Does the right hon. Gentleman accept that that was exactly the same proposal as his party’s Government put forward just before they left office?

[Andy Burnham]

Just as the Government’s proposal is not the Dilnot report, it is not my national care service proposal. I had a range of different proposals, and that one has to be considered in that context.

As the Minister knows, I proposed a universal approach in which everybody would contribute on the NHS principle—I seem to remember that he and I were in some agreement about that. That was a deferred payment, but this proposal is different. The Government are talking about a universal deferred payment scheme in which people will pay from what they leave behind, but—and this is the point—it will not be available to everybody. That was the promise the Minister has broken.

[Grahame M. Morris]

My right hon. Friend is making excellent points. On deferred payments, this proposal has been presented as something new, but is it not the case that about 90% or 95% of local authorities currently offer a similar scheme?

[Andy Burnham]

They are offering a similar scheme but at the moment they are not allowed to charge interest on it. That brings me to the next part of what is wrong with these proposals. What the Health Secretary has not said today is that interest will be charged on his proposed deferred payment scheme, which is not universal because it is not available to everybody. A loan to cover the average length of stay in a care home—two and a half years—would clock up extra costs of £3,500 in interest alone. That interest would not be included in the cap but would be outside it. Again, people will not feel that what they are paying is related to a cap.

[Mr Jeremy Hunt]

rose—

[Andy Burnham]

I noticed that the Secretary of State was not very good at giving way, and I hope in future he will bear that in mind.

[Mr Hunt]

I am most grateful. Will the right hon. Gentleman confirm that the impact assessment for his policy stated that interest would be charged under his own plans?

[Andy Burnham]

I was proposing a fundamentally different policy in a national care service. I ask the Secretary of State politely whether it is about time he stopped trying to say that everything is about the past? Why did he not stand there, explain and justify his own policy? Would that have been a good thing for him to have done today, instead of leaving it to me to explain what he is proposing?

[Mr Stephen Dorrell (Charnwood) (Con)]

In the interests of explaining his policy, will the right hon. Gentleman confirm that the answer to the question posed by the Secretary of State and the Minister was, “Yes”?

[Andy Burnham]

I say again, with all respect to the Chair of the Health Committee, that I was proposing a fundamentally different scheme to that in the Bill. I was proposing a universal all-in scheme, and several steps were put forward to get us to that. The right hon. Gentleman knows that because the Conservative party and those on the Government Front Bench put posters up about that scheme before the last election. Does he remember that? [Interruption.] He nods, right—that was my proposal, but it is not the Government’s proposal, which is different. I proposed various steps to get to my scheme. Is it about time the Government started answering for their proposal, rather than for mine?

[Barbara Keeley]

My right hon. Friend is being generous in giving way, and I guess we ought to move on shortly. There is all this harking back to our policies, but I understand—I was here—that steps were taken towards Labour’s national care service, including the Personal Care at Home Act 2010 that would have helped 400,000 people, not the 100,000 who will be helped by this Bill—if, indeed, it ends up being 100,000. Is my right hon. Friend, like everybody else, totally disappointed with the Government’s lack of ambition to help people?

[Andy Burnham]

I completely agree, and it is unfair that older people have not been given a full picture. People need proper information to plan for the future, and they have not been getting that today. People need the facts. Spin is of absolutely no use to them whatsoever, but that is all that is on offer from this Secretary of State. The truth is that in the end, the Bill will not stop catastrophic care costs that run into hundreds of thousands of pounds, or stop people losing their homes. It will not improve services now as it promises only a vague review of the practice of 15-minute visits, and strips the Care Quality Commission of its responsibility to inspect local authority commissioning, which is often responsible for such things.

[Mrs Moon]

Will my right hon. Friend give way?

[Andy Burnham]

I will make some progress and turn to part 2 of the Bill and measures related to the NHS. It would help to get a few facts clear. The Secretary of State seeks to denigrate Labour’s record at every opportunity, but let me remind him that the Labour party left an NHS rebuilt with the lowest ever waiting lists and highest ever public satisfaction. The previous Labour Government introduced independent regulation of NHS hospitals for the first time, prompted by previous scandals at Bristol, Alder Hey and the Shipman murders. The Secretary of State should cast his mind back a little further before coming to the House and making unfounded allegations.

As Robert Francis rightly acknowledged in his report, there was no system of independent regulation before 1997. It was the independent regulator that first uncovered the failings at Mid Staffs and, later, at Basildon. As the party that introduced independent regulation in the NHS, Labour has no problem with strengthening it and providing legislative backing for the appointment of chief inspectors for hospitals, general practice and social care, but let us be clear: those were not recommendations of the Francis report.

The Secretary of State accused us of not supporting the Francis report. We do support the report; it is the Government who are not implementing its recommendations. Just as part 1 of the Bill fails to implement the Dilnot report, part 2 fails to implement the Francis report. One of the report’s central recommendations was for a statutory duty of candour for individuals, but the Government are proposing that it should apply only to organisations. How will an organisational duty help individuals to challenge an organisation where there is a dysfunctional culture? It will not, and we urge Ministers to think again. They also need to clarify whether the duty will cover the most serious incidents, and whether it will apply to all organisations that provide NHS services, including outsourced services.

My main objection to part 2, however, is that it embodies the huge contradiction that now sits at the heart of Government health policy. The Secretary of State talks of independence for the Care Quality Commission in the same way as the Health and Social Care Act supposedly legislated for the independence of the NHS, but this is the Secretary of State who has taken to ringing up hospital chief executives who are not meeting their A and E targets. The Secretary of State nods, but that is not “independence of the NHS”. This is the Secretary of State who holds weekly meetings with the supposedly independent CQC, Monitor and NHS England. What precisely is the Government’s policy on independence? People are becoming confused. Clause 118 makes it clear that the Secretary of State wants more control: he wants sweeping powers to close hospitals without proper consultation and clinical support.

[Dame Joan Ruddock]

Does my right hon. Friend recall that in the case of the failing South London Healthcare NHS Trust, the trust special administrator got his financial projections wrong? He massively overspent his own budget, and failed to point out the consequences for the solvent Lewisham hospital, which was in a different trust and which, as a result, did not consult on them. Does my right hon. Friend imagine that there is any way in which such a consultation could take place and produce good outcomes in just 100 days?

[Andy Burnham]

I pay tribute to my right hon. Friend. She and the people of her community stood up to an arrogant Government, and won a victory for every community that was worried about the future of its hospital. One would have thought that, following humiliation in the courts, the Government would have backed off gracefully, but no: here comes the Secretary of State again today, like someone who, having been caught breaking in through the back door, has the brass neck to return and try to force his way in through the front. Well, we will not let him get away with it. We give him notice that clause 118 is wrong, that it is an affront to democracy, and that we will oppose it every step of the way.

Hospital reconfiguration should always be driven by a clinical case first and foremost, but clause 118 paves the way for a new round of financially driven closures. It rips up established rules of consultation and the clinical case for change. It allows the Secretary of State to reconfigure services across an entire region for financial reasons alone, which means that no hospital, however successful, is safe. The House needs to stand up to this audacious power grab by the Executive.

[Joan Walley (Stoke-on-Trent North) (Lab)]

The clause introduced in the House of Lords gives extra powers to the trust special administrator. Are we not now faced with a complete contradiction? Rather than clinical commissioning groups commissioning services, the TSA will commission long-term services, and there has been no proper consultation. In Mid Staffordshire and North Staffordshire, for example, we have had a consultation procedure that has taken no account whatsoever of services in North Staffordshire.

[Andy Burnham]

That illustrates the confusion that is currently at the heart of the NHS. No one knows who is in charge of anything. What if CCGs and the boards of foundation trusts disagree with the conclusions of the TSA? How will that be resolved? Were we not told that doctors were sovereign? Were they not supposed to decide everything? Was that not the big call when the Government introduced their Bill? It seems that that is no longer the case: everything can be done “top down” by the Secretary of State. It takes power away from every Member and could be used as a back-door way to railroad through unpopular changes.

The real danger of the proposal comes when it is seen in the context of the competition regime created by the Health and Social Care Act 2012. Of course, it is sometimes necessary to make changes to local health services beyond just a failing trust. That is best done through partnership and collaboration, but such sensible changes are now being blocked by the market madness imposed by the Act. We recently saw the ludicrous spectacle of the Competition Commission intervening in the NHS for the first time to stop the sensible collaboration between Bournemouth and Poole. Since when did competition lawyers decide what was best for patients?

[Mr Jeremy Hunt]

What has that got to do with the Care Bill?

[Andy Burnham]

One reason the Lewisham clause is so worrying is that simple collaboration between hospitals to solve financial problems is no longer an option to ease financial pressures. That is what it has got to do with the Care Bill. The Government are making a case for all hospitals standing or falling on their own, and in that context, the weakest can be picked off by the Secretary of State and closed without consultation. Given the financial pressures on many organisations, this special administration process is likely to be used on an increasing basis, putting more hospitals at risk. That should send a shiver though every community represented in the House today.

[Mr Jim Cunningham (Coventry South) (Lab)]

Does my right hon. Friend agree that the Government seem to have adopted a drip, drip, drip strategy to discredit the NHS? I can remember him proposing a national care service some months before we left office, but the Conservatives rejected it.

[Andy Burnham]

They did, and they put those posters up at the election to try to scare older people—I do not know how they thought that was appropriate, in the same way I do not know how their contributions today have been appropriate.

What my hon. Friend the Member for Coventry South (Mr Cunningham) says is exactly what is happening. People are not daft. They can see what is going on. They saw a Government legislate to place the market at the heart of the NHS in a way that means we now have the Competition Commission making decisions and forcing services out to open tender. We also have a Secretary of State who does not waste a day running down the NHS—“uncaring nurses”, “lazy GPs”, “coasting hospitals”; everything undermined, everything wrong—rather than celebrating good care. That is the agenda. They are softening the NHS up for more privatisation.

That will be the big choice come the next election. The Secretary of State can spin whatever lines he wants from that Dispatch Box, but that is the choice: a public, proud NHS under Labour, or a fragmented market under the Conservative party. I know which side of the debate I am on, and that is the choice we will put to people.

[Charlotte Leslie (Bristol North West) (Con)]

Independent sector treatment centres—the right hon. Gentleman’s party started competition!

[Andy Burnham]

Across the NHS, people are spending millions on competition lawyers thanks to the Bill that the hon. Member for Bristol North West (Charlotte Leslie) and others passed. That is being cited as the major barrier to the integration that the Secretary of State claims he wants. Let me quote the NHS chief executive to back up that point. He recently told the Health Select Committee:

“What is happening at the moment…we are getting bogged down in a morass of competition law…causing significant cost in the system and great frustration for people in the service about making change happen… In which case, to make integration happen we will need to change it”.

By which he meant the Health and Social Care Act. It could not be clearer. It is the biggest barrier to the integration of care and support for older people. That is understood across the NHS, but the Bill does nothing about it.

Instead, the Government have left an NHS bogged down in competition law. How did it come to that? Who voted for that change? Who gave this Prime Minister and this Health Secretary permission to do something that Margaret Thatcher never dared—put the NHS up for sale? The answer is no one. Ministers talk the talk about integration, but they have legislated for fragmentation and privatisation, and the Bill does not change that. Only Labour will repeal the Health and Social Care Act, and that will be the big choice, as I say. We will bring health and care together, creating a public service working for the whole person. That is the only way we can reshape health and care services around individuals in their own homes.

In conclusion, the Bill makes some sensible changes that we will not oppose, but as our reasoned amendment makes clear, it falls far short of the durable solution that England needs. Social care in England is getting worse, not better, and the Bill does nothing to change that. It will not stop people having to lose their homes and savings to pay for care, and in the end it deceives older people about the amount they might have to pay for care, which is fundamentally wrong. Older people deserve better, and it will fall to Labour to have the courage to deliver it.

[Several hon. Members]

rose—

--- Later in debate ---

[Mr Dorrell]

Of course I accept that if we have more money, we can do more, but I do not think that that exempts us, particularly given the public finances we inherited in 2010, from the obligation to see how we can get more for the £125 billion of taxpayers’ money that is already committed to health and social care in England.

That brings me to clause 3. The only way to deliver person-centred care and early intervention to prevent avoidable cases, is to reinvent care on a much more integrated model between the national health service and the social care authorities. That is why there is the obligation in clause 3 to consider integrating health and care. In that way we will not think of the NHS as one bureaucracy and social care as another, but instead think of it, as Mike Farrar said when he was at the NHS Confederation, as a care system that provides medical support when necessary, rather than as a medical system that provides care support when it has got the money—that is how not to do it.

[Andy Burnham]

The right hon. Gentleman will recall that the NHS chief executive stood before him and his Committee saying that the competition legislation was the biggest barrier to achieving the vision he is rightly describing; he and I agree about the vision of person-centred services in the home. If the NHS is saying that before his Committee, why does he say that the competition regime is irrelevant? Is it not fragmenting care, rather than integrating it?

[Mr Dorrell]

I did not say it was irrelevant; I said it was not germane to this Bill—and in the seven minutes remaining to me, I am not going to cover that. All I will say to the right hon. Gentleman is that the difficulty with competition policy that the NHS chief executive talked about is a difficulty that health care systems around the world—in north America and in continental Europe—are finding as well. I agree with the right hon. Gentleman, however, that we need to look at how competition policy can be aligned with the policy prescriptions I am describing.

I now want to list the fourth key premise upon which this Bill is based; in what must be a short speech, I can list only four. It is around the well-being of individuals; it is around early intervention and prevention; it is around integration; it is also, critically, for the first time in statutory form, around doing needs assessments that take account of the needs not just of the individual person, but of their carer and social context as well. In that way, the support that is provided to individuals takes account of the context in which they live, rather than treats them as individuals divorced from the carers and people who care for them when the statutory social worker is not there.

The Opposition spokesman said this is an enormously ambitious set of objectives, and I entirely agree that the objective of redefining the delivery of health and social care in a way that matches the aims set out in the first three clauses and clause 10 around carers is ambitious. The objective is to re-imagine care so that we think of the health and care system not as being primarily around acute hospitals, but as a system designed to meet the needs of that majority of people who are the main focus of those who work in the service—people who primarily have a care need with an occasional medical or clinical requirement. In other words, this is about thinking about the system from the front end rather than viewing it from the top of the bureaucracy. I commend this Bill because I believe it sets that framework in statute.

I also commend the Government because they are not just setting out these aspirations as commitments in law. It is one thing to change the law. It is another thing to change the way the service is actually delivered on the ground. The most effective step the Government have taken to achieve this re-imagination of care is the £3.8 billion that my right hon. Friend the Secretary of State talked about. That is £3.8 billion voted into the NHS but available only if the service at local level delivers the joined-up, person-centred care that is set out in the first three clauses of the Bill. So this is not just a set of wordy aspirations; it is a set of aspirations supported by the resources necessary to deliver the change in the care model that the Bill describes. The £3.8 billion is the catalyst that will allow us to deliver the objectives.

With respect to those on the Opposition Front Bench, it is wrong to say that it is only £3.8 billion out of £125 billion. The £3.8 billion is the minimum that the law will require to deliver integrated care within a locality, through the health and wellbeing boards that are much beloved of the right hon. Member for Leigh (Andy Burnham) and which were legislated for by the Government. This is an important step forward. If the health and wellbeing board in a locality can see a way to use health resources to deliver a changed model of care that puts more focus on prevention and on individuals through the delivery of more joined-up services, there is no constraint in the legislation, as I understand it, to prevent more than £3.8 billion from being used for the delivery of that objective.

Resources are important in this regard. This is partly about the £3.8 billion from the taxpayer, but it is also about individual resources. It is about individual users having their right set out in the Bill to engage with their personal budgets and with direct payments, enabling them to make real choices about how joined-up, person-centred care will work best for them. It is the curse of these health debates to imagine that we can gather 650 people together in this Chamber and work out how we are going to deliver £125 billion-worth of care in a way that will work for an individual old lady in her own home. That is nonsense; we need to engage the people themselves in the decisions on how the resources are used. We also need to assure them that they will not be exposed to catastrophic personal losses by making their own contributions to their care. That is why I welcome the fact that, despite what the right hon. Member for Leigh says, the Bill gives effect to the basic propositions set out in the Dilnot report.

The Bill sets out the vision of person-centred, joined-up, integrated care, and the Government have set out plans to commit resources to turn those fine words into deeds. Also, through the establishment of an independent Care Quality Commission, the Bill will provide independent assurance about the quality of care that is provided right across the health and care system. The right hon. Gentleman claims credit, as he is entitled to do so, for the fact that the previous Government took the first faltering steps down the road to introducing proper regulation of health and care provision, but he cannot possibly believe that the Care Quality Commission that he bequeathed was fit for purpose. If he does, he is the only man in the kingdom to do so. I welcome the fact that this Government are putting in place new management and, importantly, a new statutory framework so that the aspirations that might have motivated the Labour Government to set up the CQC will now be delivered in reality.

--- Later in debate ---

[Norman Lamb]

I note the position in Salford, and I recognise that finances in local government are tight. However, the Opposition have not recognised that 108 councils were already providing social care with substantial need as the eligibility criterion before the general election. They never mention that, but it is the truth.

Baroness Campbell has called the continuity of care provisions a “landmark reform”. Although we have heard the suggestion that we have somehow moved away from what Andrew Dilnot suggested, he has said:

“For the first time you don’t have to be terrified of the consequences of needing care…this system will radically reduce anxiety…It doesn’t seem to me that it’s so different from what we wanted.”

Several references have been made to the funding of social care, and as I have said, I fully recognise the tough financial settlement that local government has faced. However, that has been necessary because of the dire state of the public finances that we inherited from the Labour Government, and we have sought to protect social care. Despite what the hon. Member for Easington (Grahame M. Morris) and others have said, a recent budget survey by the Association of Directors of Adult Social Services showed that most of the savings that local councils have made have come through efficiency changes, and that services have largely been protected. [Interruption.] Well, that is what the survey showed.

As the population continues to age, our health needs become more complex, and it is essential that we continue to adapt. We need to ensure that the care and support system is sustainable, and the Bill lays the foundation for that sustainable system. At the top of the agenda has been the issue of how we pay for care. The current system simply does not work and is not fit for the 21st century. Too many people have faced catastrophic care costs and had to make impossible financial decisions at a time of huge personal crisis. It is deeply unfair. If someone who has worked hard all their life and budgeted carefully is unlucky enough to be diagnosed with dementia or some other condition, they lose pretty much everything they have ever worked for.

Through the Bill, we are putting an end to that unfair system. We have addressed how people can plan and pay for their care, following on from Andrew Dilnot’s recommendations. We have listened carefully to what he and his colleagues have said, and we have been absolutely consistent about how these reforms will support people to plan for their future effectively. From April 2016, extending the means-test support to £118,000 will immediately result in 35,000 more elderly people receiving financial help with their care costs. That figure will rise to 100,000 people getting extra help by 2024-25.

[Andy Burnham]

Can the Minister guarantee to older people listening to the debate this evening that nobody will pay more than £72,000 for their care—yes or no?

[Norman Lamb]

Of course we have made it clear that people can choose to spend more, but I can say absolutely that by 2024-25, far more people—100,000 people—will be getting more financial support than under the system we inherited from the Labour Government. Everyone will be protected from catastrophic costs through the reassurance provided by the cap on care costs.